Provider Demographics
NPI:1730828336
Name:ORTIZ AGUNDEZ, JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ORTIZ AGUNDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:
Other - Last Name:ORTIZ AGUNDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:160 CALLE TARRAGONA
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5523
Mailing Address - Country:US
Mailing Address - Phone:939-209-1369
Mailing Address - Fax:
Practice Address - Street 1:8131 CALLE CONCORDIA
Practice Address - Street 2:STE 101
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1535
Practice Address - Country:US
Practice Address - Phone:787-842-5315
Practice Address - Fax:787-813-2626
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22732208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice